Written By: Longjam Dineshwori | Updated : November 17, 2020 9:42 AM IST
Steroids are anti-inflammatory medicines that are typically used to treat rheumatologic diseases. © Shutterstock
In the absence of a cure or vaccine for COVID-19, medical professionals are trying to repurpose existing drugs to treat the new disease. In India, the Union health ministry has included antiviral drug remdesivir, arthritis drug tocilizumab, anti-malarial drug hydroxychloroquine in the treatment protocols for COVID-19 patients under the 'investigational therapy'. In addition, corticosteroids, commonly referred to as steroids, are allowed for treatment of coronavirus patients in moderate to severe stages of illness.
But a new study has cautioned that steroids such as dexamethasone should be reserved for the sickest COVID-19 patients. These drugs can backfire in patients whose immune response is already suppressed, they stated in the study published in the journal Science Advances.
Steroids are anti-inflammatory medicines that are typically used to treat rheumatologic diseases, like rheumatoid arthritis, lupus or vasculitis (inflammation of the blood vessels). Dexamethasone has been used to treat acute respiratory distress syndrome (ARDS) or worsening of lung inflammation. This is a severe complication of respiratory infections, like influenza and COVID-19, resulting from exaggerated immune response to the viruses. This occurs when the body releases too many cytokines into the blood too quickly known as cytokine storm. Cytokines play an important role in normal immune responses, too many of them can lead to hyperinflammation and tissue damage. In fact, cytokine storm has been linked to mortality in COVID-19 patients.
Therefore, steroids like dexamethasone are prescribed to treat cytokine storms in COVID-19 patients.
In a study, scientists from the Washington University School of Medicine and St. Jude Children's Research Hospital in the US assessed the levels of the immune system protein cytokines, and other health markers in 168 adults with COVID-19. More than 90 percent of these patients were hospitalised, and about half were in the intensive care unit (ICU). They also compared the reports of the COVID-19 patients with those of flu patients and healthy volunteers.
They found that fewer than 5 percent of the COVID-19 patients, including some of the sickest individuals, had the life-threatening, hyperinflammatory immune response known as the cytokine storm syndrome.
Rather than life-threatening hyper-inflammation, most adults with moderate-to-severe COVID-19 have a suppressed immune response against the novel coronavirus, they said.
Overall, the average person with COVID-19 also had less inflammation than the average person with flu.
Based on the findings, the scientists concluded that steroid treatment might only be effective in a minority of patients with the hyperinflammatory profile. They also cautioned that dexamethasone and other steroids can backfire in patients whose immune response is already suppressed.
What is needed is a fast, reliable, and inexpensive test to measure cytokines and identify patients who are most likely to benefit from dexamethasone treatment, they added.
In September, the World Health Organization (WHO) updated its guidance on the use of corticosteroid drugs in patients with Covid-19 based on findings from a study data analysis.
The analysis of seven international clinical trials showed that corticosteroids including hydrocortisone, dexamethasone and methylprednisolone were beneficial in the sickest patients.
The drugs improve survival rates in Covid-19 patients who required admission to intensive care in hospital, mitigating the risk of death by 20%. The findings were published in the Journal of the American Medical Association.
Based on these findings, the WHO updated its treatment guidance recommending the use of corticosteroids to treat patients with severe and critical Covid-19. However, it cautioned not to use corticosteroids in the treatment of patients with non-severe Covid-19 as "the treatment brought no benefits and could even prove harmful."
Steroid treatment should be under supervision of a clinician, WHO noted.
